Laparoscopic versus Hybrid Approach for Treatment of Incisional Ventral Hernia

Abstract

Background: The aim of this study was to compare the efficacy of a hybrid approach (HA) versus laparoscopy in reducing the risk of complications related to complex adhesiolysis in incisional ventral hernia repair (IVHR). Methods: This study included 269 adult patients who underwent laparoscopic IVHR at the Oulu University Hospital, Finland during 2006-2012. Baseline, operative and postoperative data was collected and compared between the treatment groups; that is, a comparison was made between the laparoscopic approach (LA, 38 patients) and the hybrid approach (HA, 24 patients). Results: In the LA group, 11 (28.9%) patients experienced postoperative complications. There were 4 undetected enterotomies that led to major complications, reoperations and one death. In the HA group, 6 (25%) patients experienced mild and moderate complications. During adhesiolysis, 4 enterotomies occurred but were immediately sutured without any complication. Conclusion: Adhesiolysis through a minimally invasive open technique may be associated with a lower risk of undetected enterotomy in patients with complex adhesions. In IVHR, the hybrid should be considered the operative method of choice when adhesions are foreseeable.

Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomized multicenter study of 1-month follow-up results

“…Nevertheless, adhesiolysis was reported as complex clearly more often in LG than in HG. Dividing adhesions openly is presumably easier [22] and thus can affect the number of perioperative enterotomies, as also seen in another study [23].…”

A new three-step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retrospective cohort

“…Despite the small sample size of these studies, a positive trend is visible in respect to hybrid procedures. The intraoperative complication rate of LIHR procedures is reported to be 9.6-13.2% [17,28,34]. Moreover, the enterotomies reported by Ahonen-Siirtola et al [28] were all detected during the hybrid procedure, while 4 of the 5 bowel injuries in the laparoscopic group were undetected at the time of surgery, and one of those patients died after developing a septic shock as a consequence of the bowel injury 69 days later.…”

“…Other studies reporting on ventral hernia hybrid repair procedures appear to be promising as well [5,19,[26][27][28][29][30][31][32][33]. However, these studies included a low number of patients and multiple types of different hernias (primary, incisional, flank or stomal).…”

“…Other hybrid procedure studies reported intraoperative complications ranging from 0 to 16.7% [5,[28][29][30]33]. In the study that reported 16.7% intraoperative complications, they only treated patients with complex abdominal adhesions [23].…”

Hybrid operation technique for incisional hernia repair: a systematic review and meta-analysis of intra- and postoperative complications

“…After full-text reading, 12 articles were judged eligible and included for final data analysis, representing a total of 1681 patients. Two articles were the short-and long-term outcomes of one randomized controlled trial of Ahonen-Siirtola et al [10,19], and ten were retrospective cohort studies [20][21][22][23][24][25][26][27][28][29]. An overview of study characteristics including methodological quality of each included study is shown in Table 1.…”